Development of Automated Algorithms to Reduce the
Surveillance Requirements for NHSN Reporting
APIC Presentation: July 2013
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Agenda
Introduction
Creating a CLABSI
Surveillance Algorithm &
Algorithm Results
Creating a CAUTI
Surveillance Algorithm &
Algorithm Results
Conclusion
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Introduction
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The focus of this project was to develop an enterprise
data warehouse (EDW) with the goal of creating an
internally developed intervention database,
surveillance screening tool, and reporting tool.
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Creating a Central Line Associated
Bloodstream Infection (CLABSI)
Algorithm & Algorithm Results
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Data Needs for CLABSI Algorithm
• Need to Identify Following Data:
o Hospital Admission and Discharge Date
•
Unit level admit and discharge preferred but not required
o Blood Culture collection data
o Blood Culture organism name
o Central Line Insertion and Removal Date
o Fever, chills, and hypotension
o Allogeneic hematopoietic stem cell transplant recipient
o GI GVHD, Diarrhea, and WBC Count
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CLABSI Algorithm for Adults
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CLABSI Results for Stanford
Status
Algorithm Score
Number of Positive
Blood Cultures
Percent of Total
Not a CLA-BSI
Not a CLA-BSI
Not a CLA-BSI
Not a CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
Possible CLA-BSI
POA
0A
0B
0C
Missing Data
Possible Secondary CLA-BSI
LCBI-2-1
LCBI-2-2
LCBI-2-3
MBI-LCBI-1A
MBI-LCBI-1B
MBI-LCBI-2A
MBI-LCBI-2B
PLCBI
LCBI-1A
LCBI-1B
LCBI-2A
LCBI-2B
7,775
2,082
1,494
442
199
495
58
0
2
246
15
2
0
21
511
334
100
0
56.44%
15.11%
10.84%
3.21%
1.44%
3.59%
0.42%
0.00%
0.01%
1.79%
0.11%
0.01%
0.00%
0.15%
3.71%
2.42%
0.73%
0.00%
13,776
11,793
100%
85.60%
1,983
14.40%
Total Blood Cultures
Total Not a CLA-BSI Cultures
Total Possible CLA-BSIs
(Required Surveillance)
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Creating a Catheter Associated
Urinary Tract Infection (CAUTI)
Algorithm & Algorithm Results
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Data Needs for CAUTI Algorithm
• Need to Identify Following Data:
o Hospital Admission and Discharge Date
•
Unit level admit and discharge preferred but not required
o Urine Culture collection data
o Urine Culture organism name and CFU/ml
o Indwelling urinary catheter insertion & removal date
o Fever (>38°C), urgency*, frequency*; dysuria*;
suprapubic tenderness*; costovertebral angle pain or
tenderness*
*No other recognized cause of symptom
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CAUTI Algorithm for Adults: Automated
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CAUTI Algorithm for Adults: Stanford
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CAUTI Results for Stanford Algorithm
Status
Algorithm Score
Number of Positive Urine Cultures
Percent of Total
Non CAUTI
Non CAUTI
Non CAUTI
Non CAUTI
Non CAUTI
Non CAUTI
Non CAUTI
Non CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Possible CAUTI
Definite CAUTI
Definite CAUTI
POA
1/2B
0A
0B
0C
0D
OE
PD
Missing
Secondary
ABUTI
SUTI-1A-1
SUTI-P1A-1
UTI-2A-1
UTI-P2A-1
UTI-2A-2
SUTI-1A
UTI-2A
5,328
459
68
39
36
7
163
1
6
40
3
105
1
31
1
4
53
34
83.52%
7.20%
1.07%
0.61%
0.56%
0.11%
2.56%
0.02%
0.09%
0.63%
0.05%
1.65%
0.02%
0.49%
0.02%
0.06%
0.83%
0.53%
Total Urine Cultures
6,379
Total Number of Not a CAUTI Cultures
6,101
Total Number of Possible CAUTI Cultures
191
Total Number of Definite
Cultures
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100%
95.64%
2.99%
1.36%
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CAUTI Algorithm for Adults: Minimum
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CAUTI Results for Minimum Algorithm
Status
Algorithm Score
Non CAUTI
POA
Non CAUTI
1/2B
Possible CAUTI
#1
Possible CAUTI
#2
Total Urine Cultures
Total Number of Not a CAUTI Cultures
Total Number of Possible CAUTI Cultures
Number of
Positive Urine
Cultures
5,328
459
3
589
6,379
5,787
592
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Percent of Total
83.52%
7.20%
0.05%
9.23%
100%
90.72%
9.28%
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Conclusion
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Conclusion
• Value added by creating an electronic algorithm
• Algorithm can be tailored to any institution with
an electronic health record
• Higher abundance of “workable” data allows for
greater efficiency in surveillance
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Questions?
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